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rOR"OFFICE USE: APPLICATION FOR SANITATION PE ,/ --------------------- Permit �y.No, _ --��--. ---.........-- ------------------------•--•...... (Complete in Triplicate] o ......... This Permit Expires I Year from Date Issuedprsttall sued Application is hereby made to the San Joaquin Local Health District for a permit to construct and the work herein described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..-. �f�-.��_ _._ � CENSUS TRACT ...._................•--, ]� ------- Owner's Name "' Phone - ------ --••---•-- ------------•-----....... --•......-••_•-----•----- .................................... Address 3 f �tt �?�_.. '1r!ff�r .... City --•----•..................•-----.........._...._._._. Contractor's Name ......L �_._1`"`'�.= ........License # ..I�l _ YPhone :...................... Installation will serve: Residence ® Apartment House❑ Commercial '❑Trailer Court 0 Motel ❑Other .._ ...� _._, Number of living units:--.-- ..... Number of bedrooms _?y...Garbage Grinder ............ Lot Size ........................... Water Supply: Public System and name ..................I........... -••--•---....._....... .................•--...................................Private Character of soil to a depth of 3 feet; Sand❑ • ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material ............ If Yes,type ............................. (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must.be placed on reverse side.). f i NEW INSTALLATION: (No septic tank or seep a pit permitted iublic sewer is available within 200 feet.} PACKAGE TREATMENT [ ] SEPTIC TANK Size_ 1 .�.l�_�� r�' !____.-__ Liquid Depth .....`.�4.............. Capacity 11-0-D------- Type .. Material---4,"L-c ---- No. Compartments __...."_-.............� Distance to nearest: Well --------,r_O..1V--------------Foundation ....... `..____ Prop. Lin .............. LEACHING LINT: [1"'�' No. of Lines ......../.............. Length of each line..---------7.-7___i ....... Total Length ---.7 r-•___--•__•--•_.-�! •D' Box ------------ Type Filter Material ...... A.......Depth Filter Material ........ ................. Distance to nearest: Well ...... ........... Foundation ../o_-i•.........._ Property Line _ --_ SEEPAGE PIT [ Depth .._....2-.7._.... Diameter .. •n___ Number ...----€�------•-_----_ Rock Filled Yes No 0 Tn Ile Water Table Depth ._hpn____________________........Rock Size ..a.!/ -_.._-- 3.._..._.. � Distance to nearest: Weil ?.0_ ...................Foundation ---I.A. --------- Prop. Line -- ----.......... V REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ........-- ................... Septic Tank (Specify Requirements) ---------•----•....................................................._...---......-..,,.,p Disposal Field (Specify Requirements) .................................. -----------------------------------•........._------ ---••------------ ----------------------------•-----••------------- ..................._..--------•-- ................. -•----------------....-•---------•--......._......--•............._...-•-----•----- -----•--------------------•------------ --------------------- ----------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- . sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...--.............................- ....... ... Owner f i BY ...................... f ' r7 '� . Title ..Ar1 (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ ............. ............ ........................ DATE ... . ........ I BUILDINGPERMIT ISSUED .........................................................................................................DATE: -.............._..---:.._._.:.__---------- ADDITIONALCOMMENTS -•-•----- ...................................... ...........I........................... ... ............................ ......_.. .��.,:...r d. ..... ... _._ ....•_....._•--•- � ..............•- ---•-•- ---- --•- -- ---•------------- ------. Final Inspection by ' Date_. SAN JOAQUIN LOCAL HEALTH DISTRICT